Misadventure in The Hospital of Infectious Diseases
Warning: Contains events not suitable for those with a brainstem vomition center that's easily excitable (whatever).
Misadventure in The Hospital of Infectious Diseases. If I remember correctly, this government-owned charity institution I was in had more than 10 wards distributed in 3 buildings. A gamut of tropical & other infectious disease cases can be found here with pulmonary tuberculosis giving the most admissions. Because of this, the tuberculosis ward had a separate building of its own. From here, let's focus on the tuberculosis ward. It had 2 floors with the second floor for the male patients while the first floor was shared by both sexes. There were 10 rooms in each floor and each room had 10 beds which seldom get vacant. The staff on one floor consists of less than 10 nurses, a resident doctor, 2 nursing assistants, a janitor and a trainee...me. I wasn't really sure of the number, but it seemed like that because the next staff I can see at the time aside from me was way across the corridor.
I thought it couldn't get worse. Being the new trainee, I was often considered the lowest in the hierarchy. I'm the all-around-errand-boy kind of nurse trainee. Even the janitor tried to boss me around. Nevertheless, the circumstances won't be enough to make my head spin...that's what I thought.
The early morning rounds... I took pride in putting the patient's neatly organized charts on bedside on time, 50 of them, especially when the resident doctor appreciated it. That's nursing art over there...yeah right. With almost a hundred patients, the rounds took forever. In the end, I couldn't understand half of the endorsement notes I've taken down. Fortunately when it was time for the morning care, I was only required to supervise the patients' companion. Imagine if there weren't companions, 50 patients would've taken me the whole day...probably longer.
In the first room that we entered, I was asked to auscultate a patient's chest and assess the adventitious breath sounds. Full of confidence, I grabbed my stethoscope and placed my patient in an upright position. After exposing and seeing the patient's chest, I was boggled. I wondered if the stethoscope can be of any use on a chest like that... the intercostal retractions were profound. The patient was really emaciated, and so were the others most likely. Still, I tried using the stethoscope even if there was a big space between the stethoscope's diaphragm and the skin over the intercostals. Rales & Rhonchi seemed audible enough just by listening closely with the naked ear anyway, but proper technique with a stethoscope should be observed at all times according to my grouchy instructor back in nursing school. It worked. At that point, I realized it was possible because from what I've read before, that was what the stethoscope's diaphragm is good for. Compared to the stethoscope's bell, it doesn't always need an even surface. Cool function. I just had to experience that to help me remember.
After the morning rounds, I started gathering the patient's charts from bedside. The beds were arranged against the four walls of the room next to each other in such a way that they surrounded me when I stood in the middle. When I went into this room, it seemed like I was in a gas chamber. What happened was after I asked one patient how he was feeling, he tried to reply but instead coughed incessantly followed by the patient next to him, then the next and so on and so forth in a chain reaction until everyone in the room was coughing...and there I was caught in the middle of the room carrying 20 charts. Aerosol droplets from diseased lungs were coughed at me in all directions. They were like a choir and I'm their conductor. I can't even cover my nose because my hands were full carrying the charts. I hurriedly went out of the room worried about the performance's finale. Since then, I made it a habit to put on double masks even if it felt uncomfortably hot. I should've done that in the first place.
A choir is not a bad idea, though...I could've taught them to hit the right notes with the proper rhythm when coughing so that there would've been harmony. At least the chorus wouldn't have to sound so bad.
-Finding humor in everything that happens to me makes the hardships easier to deal with.-Last edit by Joe V on Oct 15, '08 : Reason: included title
Oct 17, '08I guess N95 masks hadn't been fitted on employees by the employee health nurse, at the time you worked there. SARS did a lot to further use of that more effective tool.
If your Tb skin test or x-ray was neg before you worked there, did you convert to pos? OSHA should have come in to evaluate your environment (yeah, there I go in hind sight again). I wish face masks could be dangled from the ceilings of "isolation" rooms, when activated by hearing coughing taking place (there's an invention for someone to market). I just came home from an airplane trip, so that was triggered by the possibility of oxygen masks coming down.Oct 19, '08@lamazeteacher: Thanks for reading. I had disposable masks before and I'm supposed to do double or triple masking. I just forgot to put it on because it's really hot and humid at the time and nobody bothered to remind me to put it on. Convert to pos...I guess not. Just had my PA/LAT CXR and I'm neg. From where I came from, TB was and is still a bit prevalent. So I'd definitely come out positive on skin testing due to long-time exposure.
Dangling face masks...now that's innovative thinking. I just hope the are enough masks for everyone, or else...you're IT.
Take care & GodblessOct 21, '08Dear Gingerbreadman:
My reaction to your post is my "kneejerk" one, regarding misinformation. As an Infection Control Nurse for many years and Employee Health Nurse, I must correct your assumptions as follows:
1.Repeated exposure to Tb doesn't necessarily convert skin tests for same. Before having a chest Xray to ascertain presence of active lesion(s), if your previous Tb skin tests have been neg., you need another one to know if you are developing antibodies to Tb, even if no lesions appear radiographically. In my 48 years + 3 years on units during my preparation to be a nurse, including Tb ones, I have never converted to a pos. skin test. (1 case in point)
2. You could put 50 "disposable" masks on your face (who told you to use multiple ones?), and still get leakage of air around them. The N95 mask is meant to be fitted by being tested for your response to sweetness (saccharine or other sweetener isn't sticky, so that is what's used), with and without it, with a large plastic tube with a hole near your mouth in it (for spraying the sweet weak solution) , placed on your shoulders and around your head, so you know what size to wear, or if you need a specially adapted mask. If the sweet taste is there, another size mask is tried, until you don't taste sweetness. The mask that fits properly (no sweetness detectyed when wearing it) can be worn multiple times as long as it's dry on the outside. Usually the employee health nurse does this at the beginning of employment of those who may be caring for a patient with TB and recommendations have been to keep it with you at all times (not dangling around your possibly sweaty, acne laden neck, (....kidding...) but in a pocket (ideally the deep one over your breast) that is free of your used tissues or $$). The test and education need to be repeated yearly along with all the other safety measures taught, by someone who has passed the testing criteria.
Ad hoc note: PLEASE VOTE NOV.4!!!! for the presidential candidate whose platform on healthcare would yield full insurance coverage for all.(and not raise your taxes if you make less than $250,000/year).
P.S. I just returned from Canada, where I saw my ophthalmologist and had culture shock upon seeing again how dingy and crowded his office is! However the equipment there is "state of the art", and as usual the emphasis is on quality of care, not surroundings. He gives the most accurate and thorough examination I've ever had.
Then I went with my sister and brother-in-law to his dentist's office (dentistry isn't included healthcare insurance there, and no policies exist for it). That office was so glitzy I went into "culture shock" again!
No wonder Canadian doctors are complaining to whoever will listen about their remuneration...... However, I've met the ophthalmologist's family (my nephew married his daughter) while skiing in CO, and they have a sumptuous chalet there, and clothes that reek of high end.....so I don't waste tears for him, and he obviously enjoys his work, without having to worry about patient retention. I told him I couldn't see a line of letters, and he said testily, "Yes you can".Oct 21, '08@lamazeteacher: Yeah, I know that disposable masks weren't enough and I've seen one of those N95 masks when I got the opportunity to have one but didn't get to use it and had to return it to the institution I was in. Point well taken. I only had disposable masks and I only intended to use it for masking odor and hoping that it could give me some sort of protection.(cheapskate) But that's how it was before working in that government institution. Not enough supplies for everyone.
I definitely need another skin test just to be certain. Thanks very much for the info. And yeah, vote for that person, whoever that is.
Take care & Godbless
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